Bagpipes were played at his funeral...
I lost a friend a few weeks ago, a fellow dentist. He took his own life under the pines of Minnesota’s north woods.
Dr. A and I practiced in the same downtown Minneapolis building before he sold his practice and moved north. He was a gentle, quiet man and a huge outdoorsman — hunter, fisherman, and skier. I suppose it is easier to do these things Up North than in the big city, so off he went.
I had lost track of Dr. A except when I would see him at study club meetings, and then I heard from a mutual friend about his suicide. We do lose track of friends, I guess.
Ernest Hemingway, who died of a self-inflicted gunshot wound in Ketchum, Idaho in 1961, began his novel For Whom the Bell Tolls with this epigraph:
No man is an Iland, intire of it selfe; every man is a peece of the Continent, a part of the maine; if a Clod bee washed away by the Sea, Europe is the lesse, as well as if a Promontorie were, as well as if a Mannor of thy friends or of thine owne were; any mans death diminishes me, because I am involved in Mankinde; And therefore never send to know for whom the bell tolls; It tolls for thee.
These words highlight a central theme of his book - that no one person stands alone, because every one belongs to a community. As a result, when someone of that community dies, his or her death diminishes all of us within that community. When the funeral bell tolls, it tolls not just for one but for all.
We in the practice of dentistry need to create community. The practice of dentistry can be conducive to isolationism. We do our dentistry within the curtains of our patients’ cheeks. Our practices are housed within four walls, each operatory separated for privacy. Only the dentist truly knows what goes on during a procedure, often even unbeknownst to the dental assistant sitting right beside him or her. Often dentists are hesitant to discuss their experiences, possibly because they are short of confidence, or fear they may be judged. All the more reason that we each develop a support system around us, and that support system is our fellow practitioners.
We can do this in a number of ways - join a study club, get involved in organized dentistry, go out to lunch with the dentist down the street. Emphasize our commonalities instead of our differences. Make an effort to get to know our fellow dentists. Consciously show that we care about each other. Be approachable yourself. Welcome others. Be real. Minimize pride. Depreciate yourself a bit to expose your humanness. Express humor. Reject elitism. Build relationships. Break down barriers. Share discoveries. Be the type of person you would seek out in a crisis. Say to others, “I understand,” or ask, “What can I do to help?” These are, after all, people who are easy to bond with because they have similar problems, similar experiences, similar successes, and similar goals.
Once friendships are forged, we need to watch out for each other. If one of us is “out of sorts”, we need to be sensitive to that, and intervene if needed. Be watchful of your colleagues. We are a community.
Our dental community, however, is cracking. There is a reason for this. We all need to live purposeful lives. We need meaning. I contend that there are changes taking place in dentistry that are challenging and eroding our profession’s true purpose. We as professionals make the promise to society to act in the interests of those we serve aboveany self-interest. We are thereby rewarded with society’s trust and respect. Many dentists today, however, have developed a sense that dentistry is number one a business, and number two a profession, and in that order. They view dentistry as a commodity bought and sold in the marketplace. To succeed is to outdo the competition — being in it to win. This, in effect, divides us and diminishes the sense of meaning and purpose that we have traditionally derived from dentistry. In a 2007 article from the Journal of the American College of Dentists, David Nash describes the culture of dentistry as a profession versus as a business.
“Traditionally, dentistry as a profession has focused on serving the oral health needs of patients and society, with the financial gain derived from such being a natural and appropriate consequence of the service provided. Today, increasing numbers of dentists understand themselves to be practicing in the marketplace of health care, competing for patients, treating patients with the primary motivation of earning a significant profit for their services. In short, they are operating within the culture of a business.”†
Therein lies the problem. We should instead practice dentistry primarily as a profession. Practicing dentistry as a business is, of course, important economically, but only if done within the context of supporting sound professionalism.
“While professionals derive financial gain from their life’s work, it is truly derivative; a by-product of fulfilling their promise or vow...in becoming a professional.”†
Dentistry as a business sees its patients’ oral health as a means to the dentist’s personal ends. We need to acknowledge our patients’ health as an end in and of itself - our meaning and purpose, not a means to our own personal ends; empathy and caring, not manipulation.
“The transformation from understanding dentistry as a profession to understanding dentistry primarily as a business results in a seemingly subtle, but actually significant, impact on one’s sense of purpose, from a meaningful and purposeful caring for patients’ and society’s oral health to being in business to make money. Life demands a ‘larger sense of purpose’.”†
How do we reconcile these two cultures — one of pure professionalism, the other of business and the marketplace? Possibly with the realization that our self-interest is natural and “okay” as a recognized part of who we are, but that it should be “grounded in the good of others — the common good. Thus emerges the notion of enlightened self-interest. While we are all self-interested, and not inappropriately so, our self-interest is best served when we reflectively rise above it and focus on the good of others.”†
Whatever the argument, pure individual self-interest hurts our patients, hurts our profession, and hurts people like Dr. A, who in the end may not have realized that the community around him loved him.
In the movie “Glory”, Matthew Broderick plays a white officer in the Civil War leading an all-black brigade of Union soldiers. While they train, they never get their chance to fight, until Broderick convinces his superiors to allow him to lead his men as the first group over a narrow isthmus in an attack on Fort Sumter. It is a suicide mission. He knows it. When riding his steed in front of his troops looking into the Confederate cannon barrels just before the charge, he gets off his horse knowing he will soon die, and watches a flock of gulls fly over the sandy beach.
In the final chapter of For Whom the Bell Tolls, Robert Jordan, the main character, wounded and alone, waits to ambush the fascist cavalry, thereby giving his friends the guerrilleros time to escape. He too knows he will soon die.
“He took a good long look at everything. Then he looked up at the sky. There were big white clouds in it. He touched the palm of his hand against the pine needles where he lay and he touched the back of the pine trunk that he lay behind.”**
Hopefully, so it was with you,
Please e-mail us at firstname.lastname@example.org or fax us at (612) 339-3618. We look forward to hearing from you not only regarding this article, but also if you have any ethical dilemmas you would like to present to the membership. Perhaps we can help you decide what to do.
*Dr. Churchill is Chair of the Minnesota Dental Association’s Committee on Ethics, Bylaws, and Constitution. He is a general dentist in private practice in Minneapolis, Minnesota.
** For Whom the Bell Tolls, by Ernest Hemingway, Scribner, 1230 Avenue of the Americas, New York, NY, original copyright 1940, renewed copyright 1968.
† These quotes and other ideas taken from the abstract A Larger Sense of Purpose by David A. Nash, Professor of Dental Education at the College of Dentistry, University of Kentucky, within the 2007 Journal of the American College of Dentists, Volume 74, Number 2.